Alexei Cherepanov of KHL Omsk Avangard died suddenly during a game in 2008 at the age of nineteen.

 

A sadly familiar scene played out this week near Ottawa when 15-year-old Tyler Kerr collapsed during a hockey game and later died. He had just returned to the bench after a shift when he lost consciousness, and was quickly tended to by coaches and volunteer firefighters. They did CPR, used an AED (automated external defibrillator) to deliver shocks, and he was taken by ambulance to a local hospital. He lived long enough to be transferred to CHEO (the Children’s Hospital of Eastern Ontario), but died some eight hours after his collapse. In this case everything went right, but the outcome was still wrong. For every sudden cardiac arrest that’s properly handled, how many more aren’t handled at all?

When’s the last time you took a CPR class? Never? Why not? No, no – don’t answer that. Your excuses are invalid. Survival rates from out-of-hospital cardiac arrest are minimal – anywhere from a dismal 2% to a slightly less dismal 10% of patients will survive. EMS providers will tell you that “saves” are rare, and those that happen generally have early CPR and defibrillation in common. With CPR classes readily available and AEDs in almost every public location you can imagine, there’s no reason why a sudden cardiac arrest patient shouldn’t have every opportunity to walk out of the hospital, and why you shouldn’t be the one to step up and help that happen.

 

What is it?

Sudden cardiac arrest (SCA) is exactly what it sounds like – the heart stops suddenly, usually with no warning symptoms. It’s the leading cause of death in athletes under 25, and it has touched amateur and professional sports again and again. SCA is not a heart attack. A heart attack (or more properly a myocardial infarction) happens when a coronary artery becomes blocked by your poor diet and lifestyle choices, and a portion of heart muscle dies. By contrast, SCA is most often due to a structural heart problem that the victim may not have even known they had. The heart stops beating in a normal, organized manner and develops a dysrhythmia (irregular rhythm). A dysrhythmic heart can’t pump blood around the body, oxygen doesn’t go where it needs to go, and the victim dies.

 

Why does this happen?

There are several causes for SCA, but by far the most common in young adults in hypertrophic cardiomyopathy (HCM). HCM is a genetic disorder in which the heart muscle thickens and muscle fibers aren’t arranged in the normal orderly fashion. HCM may or may not also involve an obstruction of the heart’s outflow tract – meaning blood may be impeded on its trip out of the heart to carry oxygen to the rest of the body. Many people with HCM may never know they have it – there may be a vague family history of fainting or exercise intolerance, or nothing at all. The thickened heart muscle pumps less efficiently, and can lead to eventual heart failure. The other problem with HCM is the possibility of dysrhythmia – that’s that whole thing where your heart stops pumping blood and just sits there beating erratically.

HCM is diagnosed by a thorough history and physical exam, an EKG, and an echocardiogram (an ultrasound of the heart that can detect the thickened muscle and outflow obstruction). This is one of the main things docs are looking for when they do a sports physical. The problem is there are several sets of guidelines for sports physicals, and nobody seems to be able to agree which ones to use. The American Heart Association puts heavy emphasis on history taking and physical exam, and actually recommends against routine use of EKG or echo as a screening tool. The NFL, MLB, NBA and NHL all screen their athletes annually, with the NBA being considerably ahead of the game – they require an annual echo and EKG on every player.

 

How do you treat it?

If you know you have HCM, you stop participating in sports. You take medications to reduce the workload on your heart, and you may need an AICD (automated implantable cardioverter-defibrillator) – an internal defibrillator that detects dysrhythmias and administers a shock to reset the heart’s electrical system.

Nerd moment: Defibrillation (shocking someone) doesn’t jump-start the heart. It interrupts the messed up electrical impulses that are causing the dysrhythmia, effectively resetting the heart so its own internal pacemaker can take back over. Yes, your heart has its own built-in natural pacemaker.

If you don’t know you have HCM and you collapse, you need CPR to keep the blood and oxygen going to (most importantly) your brain, and you need a shock to get your heart back on track. Studies have shown that bystanders using an AED to deliver shocks can increase survival rates of SCA victims to 15 to 30%. Survival rates when nobody does CPR or uses an AED? Zero. Obviously there’s no guarantee that every SCA victim can be saved, but if increase in survival with bystander CPR and AED use don’t convince you that you need to go take a class, then there’s something basically wrong with you.

 

Okay, so I want to take CPR.

Are you in the US? The American Red Cross and American Heart Association offer CPR classes all the time. For around $100 you can learn adult and child CPR, and how to use an AED, and the certification is good for two years. You can even take a hybrid classroom/online course (there go your “I don’t have time” excuses). You can have them put on a class for your co-workers, hockey team, or friends. In fact, if you’re a hockey coach, why haven’t you had your team take a class yet? Don’t want to come off the cash for a class? Google it. Lots of communities offer completely free CPR training. There go your “that’s too expensive” excuses.

Are you in Canada? St. John Ambulance offers CPR courses. So does the Canadian Red Cross. There’s the same range of costs you’ll find in the US – slightly more expensive options in the $100 range, and some completely free courses. The Ottawa Paramedic Service puts on free introductory CPR/AED courses from time to time. Did I mention that you can google it? You can. Google it. Go find yourself a free course and quit making excuses.

 

Stop making excuses. Take CPR. Save a life.

Comments (13)

  1. Check with your local rink if they have an AED… if they do great, find out where it is, if its batteries and pads are up-to-date and make sure someone can get to it at any time.

    If your local rink doesn’t have an AED demand they get one. If they don’t feel like putting out the cash for it hold a tournament to raise money. Win, win here; everyone gets to play more hockey and you get a life saving device should the worst ever happen.

  2. Wasn’t there a JAMA or NEJM article which found that these arrests almost never respond to CPR? Don’t get me wrong, I’m not excusing not being CPR trained or having an AED around, but it seemed like even when trained personnel [docs and first responders] were on site and gave CPR immediately there was still almost no chance of revival. As the father of a young player, believe me, I think you should do everything you can , but I thought there was something inherently different in these cardiac arrests in young atheletes. Screening has been shown to reduce these deaths, but I don’t know how expensive they are and if it’s possible to make them part of a standard sports physical.

    • The fact is a good history & physical will dictate if more expensive testing (EKG, echo) needs to be done. An H&P is inexpensive. Yes, EKG and echo aren’t, but you shouldn’t get that far if you don’t need it. A “standard sports physical” should include the specific questions that can tease out the possibility of HCM – and extra questions cost nothing.
      Studies have shown that out-of-hospital arrests ***from all causes*** have better survivability rates with early CPR and defibrillation, and in fact that’s what prompted the recent changes in AHA CPR guidelines from the old ABC (airway, breathing, circulation) to the new CAB (circulation, airway, breathing). The upshot is that quality early CPR has demonstrable benefits.
      As concerns HCM specifically, the upswing in the use of therapeutic hypothermia (cooling the victim to 32 degrees celcius for a period of time after they regain a pulse) in post-arrest patients is showing definitive benefits for both survival and neurologic recovery. Now I can’t give you specific numbers for survival of an HCM arrest with early CPR and defibrillation off the top of my head, but I can tell you from personal experience that these patients DO survive, and as I stated, numbers for ALL causes show improvement with CPR/AED. I don’t see the value in teasing apart causes in this forum. The simple fact is that CPR/AED use by bystanders helps.

  3. “A heart attack (or more properly a myocardial infarction) happens when a coronary artery becomes blocked by your poor diet and lifestyle choices, and a portion of heart muscle dies.”

    Don’t discount genetics. Plenty of seemingly healthy people die of heart attacks every year. Pretty much every male on my father’s side has died of a heart attack, many of them exercise, eat well, and limit drinking. Yay for me!

  4. Another thing to remember is that an AED (or at least any of those I’ve seen here in the States) is ridiculously easy to use. It talks to you. And in that it is “automatic”, it’s not going to shock unless the machine detects a shockable rhythm. So I don’t buy the excuse of bystanders not applying it because they haven’t been trained and are afraid of hurting the patient. By all means, I’m all for promoting CPR/AED training, just saying not being trained shouldn’t stop someone.

    Also, adding to the changes in CPR guidelines from ABC to CAB, remember the change in compressions to breaths ratio from 15:2 to 30:2, placing more emphasis on chest compressions. At the very least, if we can keep that blood circulating with compressions alone, the body will continue to pull out what oxygen is left in the blood, which is 100% better than doing nothing at all.

    Please- every one should be certified in CPR/AED. Check out local churches, schools, scouting groups, local hospitals, places of work- tons of places offer basic certification classes on the cheap, $20-$30 for a few hour course. Most definitely worth the money if you can help “buy someone time”, as one of my instructors used to say.

  5. For swedish readers, the swedish red cross offers CPR-training: http://www.redcross.se/detta-gor-vi/kurser/kurser-i-forsta-hjalpen/

  6. I was on the ice when a teammate collapsed during practice and was a responder performing CPR until the medics arrived. Unfortunately, he did not survive. It can seem futile when you read – or directly experience – the low rates of survival. I struggled myself with the feeling of futility afterwards, but helplessness would have been the only thing that felt worse.

    For your teammates, for your friends, for your family, for anyone – give them every chance to be one of the lucky survivors. Get trained. http://www.redcross.org/cpr

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